Research article Journal of Oral & Dental Health

Evaluation of Anti-Cariogenic Properties among Four Types of Glass Ionomer Cements

Ahmed Mohammed El-Marakby1*, Sara Abdulrahman Alfawaz2, Sultan Ali Alanazi3 and Khalid Tawfik A.
Alduaiji4
1
Assistant Professor in the Department of Restorative Dental
Sciences, Al-Farabi colleges, Riyadh, Saudi Arabia and Lecturer in Corresponding author
*

Operative Dentistry Department, Faculty of Dentistry, Al-Azhar Ahmed Mohammed El-Marakby, Assistant Professor in the
University, Assiut branch, Egypt. Department of Restorative Dental Sciences, Al-Farabi colleges,
Riyadh, Saudi Arabia and Lecturer in Operative Dentistry
Dental internship, Al-Farabi colleges, Riyadh, Saudi Arabia.
2
Department, Faculty of Dentistry, Al-Azhar University, Assiut
branch, Egypt, E-mail: drahmedmarakby@yahoo.com.
Dental internship, Al-Farabi colleges, Riyadh, Saudi Arabia.
3

Submitted: 10 May 2017; Accepted: 16 May 2017; Published: 19 May 2017

Dental internship, Al-Farabi colleges, Riyadh, Saudi Arabia.
4

Abstract
Objectives: The aim of this study was to evaluate the anti-cariogenic property (Fluoride ion release and its antibacterial
properties) among four types of glass ionomer cements used as a permanent filling of caries cavities.

Materials and Methods: Four types of glass ionomer cements were used in this study [1]. Fuji IX (GC, Japan);
Conventional glass-ionomer cement, Fuji II LC (GC, Japan); Resin-modified glassionomer cement (RMGIC), Dyract AP
(Dentsply, Konstanz, Germany); Polyacid-modified composite resin (compomer) and Ketac N100 (3M ESPE St. Paul,
MN, USA); Nano-filled resin-modified GIC [2-4]. The antibacterial activity of each material was evaluated against the
Streptococcus mutans after day 2,7,14 and 30.

Results: All types of GIC restorative materials developed antibacterial activity but decreased depending increased the
tested time.

Conclusion: The best one developed antibacterial activity was Fuji IX (GC, Japan); Conventional glass-ionomer cement
followed by Ketac N100 (3M ESPE St. Paul, MN, USA); Nano-filled resin-modified GIC while the least one was Dyract
AP (Dentsply, Konstanz, Germany); Polyacid-modified composite resin (compomer).

Keywords: Resin modified glass ionome, Compomer, Nanoionomer,
Streptococcus mutans.
Introduction
Dental caries process mostly started with infection by cariogenic
bacteria, leading to acid production as a result of the bacterial
carbohydrates metabolism within the oral biofilm. Lactic
acid which is the main acid of metabolism, attack the mineral
components of the tooth, leading to a process of demineralization,
with subsequent degeneration of the organic component and finally
a cavity is formed within the tooth [1]. Before the development of
the cavity, a carious lesion looks like a white spot with a relatively
intact, mineral-rich, but porous surface. It covers a subsurface area
with a reduced mineral content [2]. Although it is known that acido-
genic bacteria play a key role in the development of dental caries
[3-4]. However, various therapeutic procedures for the treatment
of dental cavities do not always eliminate all microorganisms from
the caries focus [5-8]. The presence of bacteria in dental tissue left
behind or bacterial invasion through a micro-leakage developing
between the tooth and the filling may result in secondary caries
[9]. Thus, antibacterial action is a desired feature of materials used
for dental filling.
Modern materials are typically designed to be resistant to secondary
caries and to micro-leakage at the edges, properties they possess
on account of their ability to release fluoride and to be bonded to
the prepared tooth surface. Margins of restorations are of particular
importance, and lack of integrity of these may significantly
increase the risk of secondary caries [10-13]. Secondary caries is,
in fact, the most frequent indication for replacement of all types of
restoration and the limited durability of dental restorations means
that some patients are in continuous restorative cycles that result
in larger and larger restorations and more complex therapeutic
measures [10, 14].
Many new filling materials, characterized by the release of fluoride
(F) ions, were developed in the last decade as a means of protection
against recurrent caries, Of these, the most important are the glass-

J Oral Dent Health, 2017 Volume 1 | Issue 1 | 1 of 5

ionomer cements and their hybrids (resin-modified glass-ionomer
cements and polyacid-modified composite resins; so-called
“compomers” in addition to newly nano-ionomer derivatives).
By releasing fluoride, these materials offer protection to the hard
dental tissues and the surrounding micro-environment [15, 16, and
17].
There are a number of mechanisms by which release of fluoride
protects the teeth. First, the presence of small amounts of fluoride
in the saliva reduces the solubility of the mineral phase of the tooth
mineral. Second, fluoride incorporated into the mineral phase leads
to the formation of a thin layer of flour-apatite, which is less soluble
even at low values of pH than hydroxyapatite. Third, fluoride may
interfere with the metabolism of cariogenic bacteria by inhibiting
essential enzyme-mediated processes. All of these mechanisms
shift the demineralization/remineralization equilibrium back in
favour of remineralization [18, 19].
Glass-ionomers, for example, have been reported to contribute to
the remineralization on incipient enamel lesions in vitro [20]. Such
studies on the effects of fluoride on dentine reveal that low fluoride
concentrations may lead to hypermineralization of dentine [21,
22]. In fact, the choice of the restorative material can be crucial in
determining whether demineralization or remineralization occurs
in the dentine tissue surrounding a restoration. Incipient caries
like lesions under glass-ionomer restorations have been found
to remineralize and even to hypermineralize, whereas amalgam
and composite restorations have been shown to be predominantly
associated with further remineralization of the specimens [19].
The distinct zone of interaction found between the glassionomer
cement and hard dental tissues contributes to the adhesion
and high resistance to microleakage of glass-ionomer cements
restorations.According to the opinion of many authors, F ions may
be responsible for the anti-microorganism action of these materials
[23-27].
Some methods have been suggested for testing the antimicrobial
effect of dental materials. The most frequently employed
methods are those based on direct contact test (DCT) [28, 29].
The direct contact test is a relatively new method that provides
the information on the bacterial viability and growth rate and
quantitatively measures the effect of direct and close contact
between the microorganisms and the tested materials, regardless
of the solubility and diffusibility of their components. The growth
inhibitory effect of GIC is considered beneficial in preventing
bacterial colonization. In addition, the antibacterial activity, during
the time, assumes clinical relevance [30].
The aim of this study was to evaluate the anti-cariogenic property
(Fluoride ion release and its antibacterial properties) among four
types of glass ionomer cements used as a permanent filling of
caries cavities.
Materials & Method
Four types of glass ionomer cements were used in this study.
[1] Fuji IX (GC, Japan); Conventional glass-ionomer cement
[2] Fuji II LC (GC, Japan); Resin-modified glass ionomer cement
(RMGIC)
[3] Dyract AP (Dentsply, Konstanz, Germany); Polyacid-modified
composite resin (compomer)
J Oral Dent Health, 2017
[4] Ketac N100 (3M ESPE St. Paul, MN, USA); Nano-filled resin-
modified GIC
Restorative materials used in this study are shown in table 1. The
antibacterial activity of each material was evaluated against the
Streptococcus mutans (ATCC#35657) this study followed the
methodology of the study of Elaheh V.D. et al [31].
Preparation of glass ionomer samples
Six wells (7 mm diameter and 3 mm thickness) were punched in
the Muller-Hilton agar plates and filled with the four types of GIC
restorative materials. A uniform surface was achieved by using a
small flat-ended dental instrument, such as a dental spatula. The
material was allowed to set in accordance with the manufacturer’s
recommendation either by chemical cure (acid base reaction) as in
conventional GIC (Fuji IX) or by light cured or both methods as
in other three types.
Table 1: Restorative materials used in this study.
Material Type Manufacturer
Fuji IX Conventional GC, Japan
glass-ionomer cement
Fuji II LC Resin-modified GC, Japan
glass-ionomer cement
(RMGIC)
Dyract AP Polyacid-modified Dentsply,
composite resin (compomer) Konstanz,
Germany
Ketac N100 Nano-filled 3M ESPE St. Paul, MN, USA
resin-modified GIC
Antibacterial activity test
Bacterial strain from stock cultures was cultivated in Brain Heart
Infusion broth (Difco, Detroit, USA) at 37°C, for 24 h. The top 4 mL
of the resulting undisturbed bacterial cultures were transferred to new
test tubes and centrifuged for 10 min at 3, 2 gravity. The resulting
supernatant was discarded and the bacteria was resuspended in 5
ml of phosphate-buffered saline (PBS) with a pH of 7.5 (Sigma-
Aldrich, St. Louis) and mixed gently by vortexing for 10 sec. We
used DCT to test the antibacterial properties and anti-cariogenic
effect of the different types of GIC. The antimicrobial susceptibility
profiles were determined by disk diffusion agar method according
to CLSI M100-S12 protocols (2005). In each sterilized Petri dish
(20100 mm), a base layer containing 15 mL of blood agar mixed
with 100 μl of inoculum was prepared. After the solidification of
culture medium, wells measuring 7 mm in diameter were made in
each plate and the testing materials were transferred to wells. Two
wells were served as the positive control without the four tested
GIC restorative materials. Plates were incubated at 37°C for 48 h
and after that, diameters of zones of inhibition produced around
the specimens were measured at three different points. The size of
inhibition zones was calculated through subtracting the diameter of
specimen (7 mm) from the average of three measurements of the
halo. All measurements were performed twice by the same blinded
operator. Antibacterial tests were repeated 5 times to confirm the
homogeneity of the results. Moreover, diameters of zones of
inhibition produced around specimens were measured after the re-
incubation of plates at 37°C for 5 days.
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Statistical analysis
The mean diameter of inhibition zone values for each material
was used for statistical analysis by using General Linear Models
to compare the inhibition zones of bacteria around each GIC
restorative material. Tukey’s studentized post-hoc tests were
performed to identify the differences among the GIC restorative
materials, the level of significance set at p < 0.001. A Tukey’s
complementary test was also used to determine if there was a
significant difference between the inhibitory effects of 2,7,14 and
30 days specimens (p < 0.001).
Results
The mean values and standard deviations of the inhibition zones for
each material according to the bacteria strain, at different days, are
shown in Table 2. There was a significant difference between the
types of GIC restorative materials according to time of evaluation
2,7,14 and 30 days and the antibacterial activity decreased by time
to reach the lowest level at day 30 as seen in (bar chart 1). The
antibacterial property of Fuji IX (conventional glass ionomer)
was the highest among all other types in all tested days with a
statistical significant difference (p < 0.001). A reduction in the
measured inhibition zones was observed in all samples after the
day 7 towards day 14 and day 30 that was not significant in both
Fuji IX (conventional glass ionomer) and Ketac N100 (Nano-filled
resin-modified GIC), but significant with Dyract AP (compomer)
and Fuji II LC (Resin-modified glass-ionomer cement(RMGIC).
Table 2: The mean values and standard deviations of the inhibition
zones for each material.
S. mutans (inhibition zones)
Materials
Day 2 Day 7 Day 14 Day 30
Fuji IX 22.80 ± 1.30 21.20 ± 1.30 20.10 ± 1.09 19.88 ± 0.09
Fuji II LC 14.0 ± 0.70 13.40 ± 0.54 11.30 ± 0.79 9.17 ± 0.71
Dyract AP 12.40 ± 0.54 11.0 ± 0.70 9.20 ± 0.34 5.11 ± 0.21
Ketac N100 15.33 ± 1.11 14.32 ± 0.75 12.67 ± 0.88 11.39 ± 0.44
Inhibitin zone in mm in relation to different tested time
Bar chart 1: showing the mean values and standard deviations of
the inhibition zones for each material.
Discussion
Prevention of secondary caries around existence restorative
material is reliant on the patient control of dental plaque. However,
J Oral Dent Health, 2017
many patients do not take care of their oral hygiene perfectly.
Consequently, antibacterial properties of permanent restorative
materials are desirable. Conventional glass ionomer presents
approving and essential properties such as biocompatibility to
dental pulp, ability of chemical bonding to enamel and dentin and
fluoride releasing, which can play an important role in the inhibition
of bacteria growth and caries progression [34-37]. Different in-
vitro methods have been used to study the antibacterial activity
of dental materials. Boeckh et al. throughout their experiments
using strains of S. mutans, showed the important role of this
microorganism in caries etiology [33]. The methodology applied
in this research was based on DCT to verify the inhibition zone
of materials evaluated and focused on the standardization of the
experimental conditions, in particular in relation to the specimens’
dimensions and microorganism suspension. According to the
results, all glass ionomer restorative materials evaluated the
inhibited bacterial growth, but with differences according to the
material. The differences in growth inhibition between these
restorative materials may be related to their inherent potency
and to different compositions [32]. Yap and others reported that
there was no antibacterial activity despite the presence of fluoride
in the agar around the set materials [38]. We found that all four
GICs almost inhibited the growth of S. mutants in the day 2. This
effect lasted for at least one week. The most credible cause of
the reduced bacterial growth after direct contact with the GIC is
fluoride release from this material combined with a pH fall around
the material as described elsewhere [39-40]. The concentration
of fluoride in a specific dental material does not reflect its rate
of release. In consequence, the antibacterial properties of glass
ionomer restorative materials are different from one material to
another. From a clinical point of view, the fluoride release of the
GICs may drop significantly with long-term usage as reported in
other studies [41-42]. Our information recommends that further
studies are required to examine the levels of fluoride release and
the effects of GICs on complex biofilms. In the present study, we
observed that the conventional glass ionomer cements (Fuji IX) had
significantly more antibacterial effect in comparison to other types
of GIC restorative materials. Other studies have also reported the
most antibacterial properties of GICs between different restorative
materials [44-45]. This could be explained by the combined effect
of low pH of GICs and their fluoride-leaching capabilities [43]. In
all experiments, the antibacterial activity measured with Fuji IX
(conventional glass ionomer) and Ketac N100 (Nano-filled resin-
modified GIC) greater than that of Dyract AP (compomer) and Fuji
II LC (Resin-modified glass-ionomer cement (RMGIC). which is
estimated to be correlated with the higher fluoride release rates
observed with the formers.
Results revealed that Dyract AP (compomer) was the least type in
antimicrobial activity. Dyract AP is a polyacid-modified composite
(compomer), which has strontium aluminium fluoride silicate
glass and strontium fluoride embedded in 1, 6 bis (methacryloxy-
2-ethoxycarbonylamino)-2, 4, 4-trimethylhexane (UDMA) [26,
46, 48]. As far as compomers are concerned, light polymerization
results in resin binding, and, despite acid-base reactions
proceeding inside the material, F release is slower [25, 26, 33, 46,
48]. According to some authors, the level of F release depends on
possibilities for its diffusion outside and not on its concentration
in the material [23, 25, 26, and 46]. This property is related to the
hydrophilicity of the material because F ions are released from
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that part of matrix into which water diffuses. Many researchers
therefore explain differences between different groups of materials
by water-sorption mechanisms [33, 46, 47, and 48].
Conclusion
Based on the results of the present study, it can be concluded
that all the evaluated GIC restorative materials displayed some
antimicrobial activity. This antimicrobial activity was time
dependent. Fuji IX (conventional glass ionomer) and Ketac N100
(Nano-filled resin-modified GIC)) were the most active antibacterial
cements. Combined with the mechanical and biological properties,
these differences should be taken into account when one is
choosing the type of GIC as permanent restoration in clinical use.
References
1. Sharanbir K, Sidhu, John W Nicholson (2016) A Review
of Glass-Ionomer Cements for Clinical Dentistry. J. Funct.
Biomater 7: 16.
2. Tantbirojn D, Douglas WH, Versluis A (1997) Inhibitive effect
of a resin- modified glass- ionomer cement on remote enamel
artificial caries. Caries Research 31: 275-280.
3. Bowden GHW (2000) The microbial ecology of dental caries.
Microbe Ecol Health Disease 12: 138-48.
4. Van Houte J (1994) Role of micro-organisms in caries
etiology. J Dent Res 73: 672-681.
5. Banerjee A, Watson TF, Kidd EAM (2000) Dentine caries:
Take it or leave it? Dental Update 27: 272-276.
6. Kidd EAM, Ricketts DNJ, Brighton D (1996) Criteria for
caries removal at the enamel-dentine junction: a clinical and
microbiological study. Br Dent J 180: 287-291.
7. Marczuk-Kolada G, Jakoniuk P, Ruczaj J (2004) Liczba
bakterii z rodzaju Streptococcus i Lactobacillus w ubytkach
próchnicowych przed i po opracowaniu techniką ART.
[Streptococcus and Lactobacillus counts in carious lesions
before and after preparation using atraumatic restorative
treatment]. Czas Stomat 57: 7.
8. Splieth C, Rosin M, Gellissen B (2001) Determination of
residual dentine caries after conventional mechanical and
chemomechanical caries removal with Carisolv. Clin Oral
Invest 5: 250-253.
9. Mjor IA, Toffenetti F (2000) Secondary caries: A literature
review with case reports. Quintessence Int 31: 165-179.
10. Savarino L, Breschi L, Tedaldi M, Ciapetti G, Tarabusi C, et al.
(2004) Ability of restorative and flouride releasing materials
to prevent marginal dentine demineralization. Biomaterials
25: 1011-1017.
11. Mjor IA, Qvist V (1997) Marginal failures of amalgam and
composite restorations. Journal of Dentistry 25: 25-30.
12. Fontana M, Dunipace AJ, Gregory RL, Noblitt TW, Li Y, et
al. (1996) An in vitro microbial for studying secondary caries
formation. Caries Research 30: 112-118.
13. Irie M, Suziki K, Watts DC (2002) Marginal gap formation
of light activated restorative materials: effects of immediate
setting shrinkage and bond strength. Dental Materials 18:
203-210.
14. Kidd EA, Toffenetti F, Mjor IA (1992) Secondary caries.
International Dental Journal 42: 127-138.
15. Williams JA, Briggs E, Billington RW, Pearson GJ (2003) The
effects of adding fluoride compounds to a fluoride-free glass-
ionomer cement on subsequent fluoride and sodium release.
J Oral Dent Health, 2017
Biomaterials 24: 1301-1308.
16. de Gee AJ, van Duinen RNB, Werner A, Davidson CL (1996)
Early and long term wear of conventional and resin-modified
glass-ionomer. Journal of Dental Research 75: 1613-1619.
17. Forsten L (1998) Fluoride release and uptake by glass-
ionomers and related materials and its clinical effect.
Biomaterials 19: 503-508.
18. Aoba T (2004) Solubility properties of human tooth mineral
and pathogenesis of dental caries. Oral Diseases 10: 249-257.
19. de Leeuw NH (2004) Resisting the onset of hydroxyapatite
dissolution through incorporation of fluoride. Journal of
Physical Chemistry B 108: 1809-1811.
20. Hamilton IR (1996) Biochemical effects of fluoride on oral
bacteria. Journal of Dental Research 69: 660-667.
21. Dionysopoulos P, Kotsanos N, Pataridou A (2003) Fluoride
release and uptake by four new fluoride releasing restorative
materials. Journal of Oral Rehabilitation 30: 866-872.
22. ten Cate JM, van Duinen RNB (1995) Hypermineralization
of dentinal lesions adjacent to glass- ionomer cement
restorations. Journal of Dental Research 76: 1266-1271.
23. Furtos G, Cosma V, Prejmerean C, Moldovan M, Brie M,
et al. (2005) Fluoride release from dental resin composites.
Materials Science Engineering 25: 231-236.
24. Itota T, Carrick TE, Yoshijama M, Mc Cabe JF (2004)
Fluoride release and recharge in giomer, compomer and resin
composite. Dent Mater 20: 789-795.
25. Preston AJ, Mair LH, Agalamanyi EA, Higham SM (1999)
Fluoride release from aesthetic dental materials. J Oral Rehab
26: 123-129.
26. Sales D, Sae-Lee D, Matsuya S, Dewi Ana I (2003) Short-
term fluoride and cations release from polyacid-modified
composites in a distilled water, and an acidic lactate buffer.
Biomaterials 24: 1687-1696.
27. Shaw AJ, Carrick T, Mc Cabe JF (1998) Fluoride release from
glass-ionomer and compomer restorative materials: 6-month
data. J Dent 26: 355-359.
28. Boeckh C, Schumacher E, Podbielski A, Haller B (2000)
Antibacterial activity of restorative dental biomaterials in-
vitro. Caries Res 36: 101-107.
29. Perez C, HIRATA R, Sérgio P (2003) Evaluation of
antimicrobial activity of fluoride-releasing dental materials
using a new in-vitro method. Quintessence Int 34: 473-477.
30. Weiss E, Shalhav M, Fuss Z (1996) Assessment of antibacterial
activity of endodontic sealers by a direct contact test. Dent.
Traumatol 12: 179-184.
31. Elaheh Vahid Dastjerdiea, Mahvash Oskouib, Elham
Sayanjalia, Fahimeh Sadat Tabatabaeic (2012) In-vitro
Comparison of the Antimicrobial Properties of Glass Ionomer
Cements with Zinc Phosphate Cements. IJPR 11: 77-82.
32. Nakajo K, Imazato S, Takahashi Y, Kiba W, Ebisu S, et al.
(2009) Fluoride released from glass-ionomer cement is
responsible to inhibit the acid production of caries-related oral
streptococci. Dent. Mater 25: 703-708.
33. Boeckh C, Schumacher E, Podbielski A, Haller B (2000)
Antibacterial activity of restorative dental biomaterials in-
vitro. Caries Res 36: 101-107.
34. Herrera M, Carrion P, Baca P, Liebana J, Castillo A (2001)
In-vitro antibacterial activity of glass-ionomer cements.
Microbios 104: 141.
35. Fischman S, Tinanoff N (1994) The effect of acid and fluoride
Volume 1 | Issue 1 | 4 of 5
 release on the antimicrobial properties of four glass ionomer
cements. Pediatr. Dent 16: 368-368.
36. Chadwick B, Roy J, Knox J, Treasure E (2005) The effect
of topical fluorides on decalcification in patients with fixed
orthodontic appliances: a systematic review. Am. J. Orthod.
Dentofacial Orthoped 128: 601-606.
37. Vahid Dastjerdi E, Poormofid H (2007) Fluoride Release from
three glass ionomers. Proceedings of the 2nd IADR Iranian
Section General Meeting. Tehran, Iran.
38. Yap A, Khor E, Foo S (1999) Fluoride release and antibacterial
properties of new-generation toothcolored restoratives.
Operat. Dent 24: 297.
39. DeSchepper E, White R, Von der Lehr W (1989) Antibacterial
effects of glass ionomers. Am. J. Dent 2: 51.
40. Svanberg M, Mjor I, Orstavik D (1990) Mutans streptococci
in plaque from margins of amalgam, composite, and glass-
ionomer restorations. J. Dent. Res 69: 861.
41. Svanberg M, Krasse B (1990) Comparative recovery of
mutans streptococci on two selective media. Caries Res 24:
36-38.
42. Behrend B, Geurtsen W (2001) Long-term effects of four
extraction media on the fluoride release from four polyacid-
modified composite resins (compomers) and one resin-
modified glass-ionomer cement. J. Biomed. Mater. Res. B
Appl. Biomater 58: 631-637.
J Oral Dent Health, 2017
43. Vermeersch G, Leloup G, Delmee M, Vreven J (2005)
Antibacterial activity of glass–ionomer cements, compomers
and resin composites: relationship between acidity and
material setting phase. J. Oral Rehabil 32: 368-374.
44. Eick S, Glockmann E, Brandl B, Pfister W (2004) Adherence
of Streptococcus mutans to various restorative materials in a
continuous flow system. J. Oral Rehabil 31: 278-285.
45. Pedrini D, Gaetti-Jardim Júnior E, Vasconcelos A (2001)
Retention of oral microorganisms on conventional and resin-
modified glass-ionomer cements. Pesquisa Odontológica
Brasileira 15: 196-200.
46. Yip HK, Smales RJ (1999) Fluoride release and uptake by
aged resin-modified glass ionomers and a polyacid-modified
resin composite. Int Dent J 49: 217-25.
47. Koranika-Kouma A, Dionysopoulos P, Koliniotou-Koubia
E, Kolokotronis A (2001) Antibacterial properties of dentin
bonding systems, polyacid- modified composite resins, and
composite resins. J Oral Rehab 28: 157-60.
48. Xu X, Burgess J (2003) Compressive strength, fluoride release
and recharge of fluoride-releasing materials. Biomaterials 24:
2451-61.
Copyright: ©2017 Ahmed Mohammed El-Marakby, et al. This is an
open-access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
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